Rural Health
Resources by Topic: Reimbursement and payment models
Medicaid Payment and Delivery System Reform: Challenges and Opportunities for Rural Health Systems
An analysis of the impact of the Affordable Care Act (ACA) on rural Medicaid programs across the U.S. Examines their acceptance of alternate payment models and their applications of delivery system reform. Provides policy recommendations supporting integrated and comprehensive primary care delivery and rural participation in value-based payment and delivery system reforms.
Additional links: Policy Brief
Author(s): Keith J. Mueller, Charlie Alfero, Andrew F. Coburn, et al.
Date: 06/2016
Type: Document
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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An analysis of the impact of the Affordable Care Act (ACA) on rural Medicaid programs across the U.S. Examines their acceptance of alternate payment models and their applications of delivery system reform. Provides policy recommendations supporting integrated and comprehensive primary care delivery and rural participation in value-based payment and delivery system reforms.
Additional links: Policy Brief
Author(s): Keith J. Mueller, Charlie Alfero, Andrew F. Coburn, et al.
Date: 06/2016
Type: Document
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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Comprehensive Primary Care Plus - A Rural Commentary
Review of Comprehensive Primary Care Plus (CPC+), a program of the Center for Medicare & Medicaid Innovation (CMMI) initiative, designed to enhance the delivery of primary healthcare and support the shift from volume-based to value-based healthcare payment. Offers a rural perspective, noting the importance and challenges of this payment model for rural healthcare.
Author(s): A. Clinton MacKinney
Date: 06/2016
Type: Document
Sponsoring organization: Rural Health Value
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Review of Comprehensive Primary Care Plus (CPC+), a program of the Center for Medicare & Medicaid Innovation (CMMI) initiative, designed to enhance the delivery of primary healthcare and support the shift from volume-based to value-based healthcare payment. Offers a rural perspective, noting the importance and challenges of this payment model for rural healthcare.
Author(s): A. Clinton MacKinney
Date: 06/2016
Type: Document
Sponsoring organization: Rural Health Value
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Association Between the Value-Based Purchasing Pay for Performance Program and Patient Mortality in US Hospitals: Observational Study
Examines the impact of Medicare's Hospital Value-Based Purchasing (HVBP) program on mortality for pneumonia, heart failure, and acute myocardial infarction by comparing data from acute care hospitals participating in the program to data from over 1,300 Critical Access Hospitals (CAHs) and 44 hospitals in Maryland not in the program.
Author(s): Jose F. Figueroa, Yusuke Tsugawa, Jie Zheng, E. John Orav, Ashish K. Jha
Citation: BMJ, 9(353), i2214
Date: 05/2016
Type: Document
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Examines the impact of Medicare's Hospital Value-Based Purchasing (HVBP) program on mortality for pneumonia, heart failure, and acute myocardial infarction by comparing data from acute care hospitals participating in the program to data from over 1,300 Critical Access Hospitals (CAHs) and 44 hospitals in Maryland not in the program.
Author(s): Jose F. Figueroa, Yusuke Tsugawa, Jie Zheng, E. John Orav, Ashish K. Jha
Citation: BMJ, 9(353), i2214
Date: 05/2016
Type: Document
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Proactively Pursuing Value-Based Payment
Profiles a program developed at a Critical Access Hospital (CAH) located in rural Washington that is transitioning from volume- to value-based care. The CEO of the hospital is working with payers to design a value-based payment contract to help the facility fund the continued transition to value-based care and hopefully create a payment model other CAHs in the state can adopt.
Date: 05/2016
Type: Document
Sponsoring organization: Rural Health Value
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Profiles a program developed at a Critical Access Hospital (CAH) located in rural Washington that is transitioning from volume- to value-based care. The CEO of the hospital is working with payers to design a value-based payment contract to help the facility fund the continued transition to value-based care and hopefully create a payment model other CAHs in the state can adopt.
Date: 05/2016
Type: Document
Sponsoring organization: Rural Health Value
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FQHC and RHC Supplemental Payment Requirements and FQHC, RHC, and FBC Network Sufficiency under Medicaid and CHIP Managed Care
Provides state health officials with guidance on Federally-qualified Health Center (FQHC) and Rural Health Clinic (RHC) payment methodologies under both Medicaid and Children's Health Insurance Program (CHIP) managed care delivery systems. Also provides guidance on FQHC, RHC, and freestanding birth center (FBC) network sufficiency standards applicable to a Medicaid managed care delivery system.
Date: 04/2016
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides state health officials with guidance on Federally-qualified Health Center (FQHC) and Rural Health Clinic (RHC) payment methodologies under both Medicaid and Children's Health Insurance Program (CHIP) managed care delivery systems. Also provides guidance on FQHC, RHC, and freestanding birth center (FBC) network sufficiency standards applicable to a Medicaid managed care delivery system.
Date: 04/2016
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Improving Efficiency and Preserving Access to Emergency Care in Rural Areas
Slides that provide background on rural hospital payment policy and strategies to preserve access to emergency care in rural areas. Discusses existing payment models and benefits and drawbacks of different models.
Author(s): Jeff Stensland, Zach Gaumer
Date: 04/2016
Type: Presentation Slides
Sponsoring organization: Medicare Payment Advisory Commission
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Slides that provide background on rural hospital payment policy and strategies to preserve access to emergency care in rural areas. Discusses existing payment models and benefits and drawbacks of different models.
Author(s): Jeff Stensland, Zach Gaumer
Date: 04/2016
Type: Presentation Slides
Sponsoring organization: Medicare Payment Advisory Commission
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Effects of Community-Based Health Worker Interventions to Improve Chronic Disease Management and Care Among Vulnerable Populations: A Systematic Review
Reports on a review of 67 studies evaluating the effectiveness of community-based health workers (CBHWs) as an intervention model for chronic disease management and care among low-income, underserved, and racial and ethnic minority populations at risk for health disparities. Discusses the roles and tasks of CBHWs, the effectiveness of their intervention, their qualifications and training, and the reimbursement and sustainability of CBHWs.
Author(s): Kyounghae Kim, Janet S. Choi, Eunsuk Choi, et al.
Citation: American Journal of Public Health, 106(4), e3–e28
Date: 04/2016
Type: Document
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Reports on a review of 67 studies evaluating the effectiveness of community-based health workers (CBHWs) as an intervention model for chronic disease management and care among low-income, underserved, and racial and ethnic minority populations at risk for health disparities. Discusses the roles and tasks of CBHWs, the effectiveness of their intervention, their qualifications and training, and the reimbursement and sustainability of CBHWs.
Author(s): Kyounghae Kim, Janet S. Choi, Eunsuk Choi, et al.
Citation: American Journal of Public Health, 106(4), e3–e28
Date: 04/2016
Type: Document
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Dental Therapy Toolkit: Summary of Dental Therapy Regulatory and Payment Processes
Reviews the payment and regulatory processes for dental therapists in Minnesota. Covers the following aspects related to practicing dental therapy: education and examination requirements, supervision, clinical experiences, practice settings, scope of practice, and more. Offers guidance on payment and billing procedures for Minnesota's Medical Assistance program for care delivered by dental therapists.
Date: 03/2016
Type: Document
Sponsoring organization: Minnesota Department of Health - Office of Rural Health and Primary Care
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Reviews the payment and regulatory processes for dental therapists in Minnesota. Covers the following aspects related to practicing dental therapy: education and examination requirements, supervision, clinical experiences, practice settings, scope of practice, and more. Offers guidance on payment and billing procedures for Minnesota's Medical Assistance program for care delivered by dental therapists.
Date: 03/2016
Type: Document
Sponsoring organization: Minnesota Department of Health - Office of Rural Health and Primary Care
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MedPAC Report to the Congress: Medicare Payment Policy, 2016
Annual review of Medicare payment policies, with recommendations to Congress. Discussions of rural aspects of Medicare payment policies are included throughout the report. Focuses on payment adequacy, Medicare Advantage, and Medicare Part D.
Date: 03/2016
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Annual review of Medicare payment policies, with recommendations to Congress. Discussions of rural aspects of Medicare payment policies are included throughout the report. Focuses on payment adequacy, Medicare Advantage, and Medicare Part D.
Date: 03/2016
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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2012-14 Profitability of Urban and Rural Hospitals by Medicare Payment Classification
Compares the total margin and operating margin of rural and urban hospitals using 2012-2014 profitability data. Analysis divides rural hospitals by the size of the prospective payment system and by the Medicare payment classification – Critical Access Hospitals (CAHs), Medicare dependent hospitals, sole community hospitals, and rural referral centers.
Author(s): Sharita R. Thomas, G. Mark Holmes, George H. Pink
Date: 03/2016
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Compares the total margin and operating margin of rural and urban hospitals using 2012-2014 profitability data. Analysis divides rural hospitals by the size of the prospective payment system and by the Medicare payment classification – Critical Access Hospitals (CAHs), Medicare dependent hospitals, sole community hospitals, and rural referral centers.
Author(s): Sharita R. Thomas, G. Mark Holmes, George H. Pink
Date: 03/2016
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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